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v1.0.0
ICD-10 Guide
ICD-10 CodesN42.3

N42.3

Billable

Dysplasia of prostate

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N42.3 is a billable code used to indicate a diagnosis of dysplasia of prostate.

Key Diagnostic Point:

Dysplasia of the prostate refers to abnormal growth or development of prostate cells, which can lead to changes in the structure and function of the prostate gland. This condition is often associated with benign prostatic hyperplasia (BPH), where the prostate enlarges, potentially causing urinary symptoms such as difficulty urinating, increased frequency, and urgency. Dysplasia can also be linked to prostatitis, an inflammation of the prostate that may result from infection or other factors. The diagnosis of dysplasia is typically made through histological examination of prostate tissue, often obtained via biopsy. Elevated prostate-specific antigen (PSA) levels may indicate the presence of prostate disorders, including dysplasia, and are commonly used as a screening tool. Urological procedures, such as transrectal ultrasound-guided biopsy, are frequently performed to assess prostate health and diagnose conditions like dysplasia. Understanding dysplasia is crucial as it may precede more serious conditions, including prostate cancer, necessitating careful monitoring and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between dysplasia and other prostate conditions like BPH and prostatitis.
  • Need for precise documentation of biopsy results and histological findings.
  • Variability in clinical presentation and symptoms among patients.
  • Potential overlap with other ICD-10 codes related to prostate disorders.

Audit Risk Factors

  • Inadequate documentation of biopsy results.
  • Failure to specify the degree of dysplasia.
  • Misclassification of dysplasia as benign prostatic hyperplasia.
  • Inconsistent use of PSA levels in documentation.

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed pathology reports, biopsy results, and clinical notes regarding symptoms and treatment plans.

Common Clinical Scenarios

Patients presenting with urinary symptoms, elevated PSA levels, or abnormal findings on imaging studies.

Billing Considerations

Accurate staging and grading of dysplasia are essential for treatment planning and monitoring.

Pathology

Documentation Requirements

Comprehensive histological reports detailing the findings of prostate biopsies.

Common Clinical Scenarios

Evaluation of prostate tissue samples for dysplasia or malignancy.

Billing Considerations

Clear communication of findings to referring physicians is critical for appropriate management.

Coding Guidelines

Inclusion Criteria

Use N42.3 When
  • According to ICD
  • 10 coding guidelines, N42
  • 3 should be used when dysplasia is confirmed through biopsy
  • It is important to document the specific type and degree of dysplasia, as well as any associated symptoms or conditions

Exclusion Criteria

Do NOT use N42.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

55700CPT Code

Prostate biopsy, needle

Clinical Scenario

Used to obtain tissue for diagnosis of dysplasia.

Documentation Requirements

Pathology report detailing biopsy results.

Specialty Considerations

Urologists must ensure accurate coding based on biopsy findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prostate conditions, including dysplasia, which enhances the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prostate conditions, including dysplasia, which enhances the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of prostate conditions, including dysplasia, which enhances the ability to track and manage these conditions effectively.

Resources

Clinical References

  • •
    American Urological Association Guidelines

Coding & Billing References

  • •
    American Urological Association Guidelines

Frequently Asked Questions

What is the difference between dysplasia and benign prostatic hyperplasia?

Dysplasia refers to abnormal cell growth that may precede cancer, while benign prostatic hyperplasia is a non-cancerous enlargement of the prostate that causes urinary symptoms. Dysplasia requires histological confirmation, whereas BPH is often diagnosed based on symptoms and imaging.